Sunday, Sep 26 - Expo Hall Opening
Sunday, Sep 26 - Job Fair
Monday,
Sep 27 - AWHONN's Block Party
Sunday, September 26, 2010
Title: Does Simulation Team Training in Obstetrics Make a Difference?
Discipline: Childbearing (CB)
Learning Objectives:
Submission Description:- Identify the blood pressure at which the administration of antihypertensive medication is indicated.
- Identify another industry or discipline that uses simulation training to improve performance.
- Discuss the results of the retrospective chart review.
Background
The simulation of high risk situations to promote learning and improve performance is not a new concept. The aviation industry is a well known example of this. Pilots must test and train in flight simulators on a regular basis. (Reznek) Nursing students train in skills labs prior to actual patient care experiences. Anesthesia and Emergency Departments are using simulation training to improve performance in emergency situations. (DeVita). An obstetrical simulation program promotes a rapid and organized response to these emergent situations. (Macedonia
Obstetric Emergency Simulation drills were conducted at the obstetrical units of both Atlantic Health hospitals in 2008. The two sites include a regional perinatal center and a perinatal intensive center. The combined total number of annual deliveries for both sites was 6,300. All simulations utilized the same scenario and were facilitated by the same personnel to provide continuity. Simulation of a patient presenting in hypertensive crisis included at least one primary care provider (MD/CNM) and two or more nurses. During the simulation experience, the use of antihypertensive and anti-convulsant medication administration was reviewed. 95% of obstetric nurses, 93% of obstetric hospitalists, and 63.5% of private attending obstetricians and certified nurse midwives at both hospital sites participated in the simulations.
The objective was to determine if the implementation of obstetric simulations specific to hypertension in pregnancy would have an impact on the care of patients.
Methods
The implementation of an electronic medical documentation system allowed for systematic data collection before and after Obstetric simulation was introduced during the second quarter of 2008. The data generation and reporting provided by this clinical decision support system increased the breadth of data that can now be accessed electronically. A retrospective chart review was conducted for all patients admitted for delivery in the Obstetrical unit at two acute care sites of Atlantic Health between January 1, 2008 and December 31, 2008.
Results
During the first quarter of 2008, prior to the implementation of the simulations, patients were administered antihypertensive medication for a systolic blood pressure greater than 180 mm Hg or 100 mm Hg diastolic 23% of the time at site A and 39% of the time at site B. During the fourth quarter, antihypertensive medications were administered for a systolic blood pressure greater than 180 mm Hg or 100 mm Hg diastolic 85.7% of the time at site A and 60% of the time at site B. This illustrates an increasing trend of administration of anti-hypertensive medication to patients experiencing hypertension.
Discussion/Conclusions
The implementation of Obstetric Simulations specific to hypertension in pregnancy increased the appropriate administration of antihypertensive medication to patients experiencing significant hypertension. Results were limited by sample size. Atlantic Health will continue to collect data to determine if this trend continues. Repeating this study in other settings should be considered.
The simulation of high risk situations to promote learning and improve performance is not a new concept. The aviation industry is a well known example of this. Pilots must test and train in flight simulators on a regular basis. (Reznek) Nursing students train in skills labs prior to actual patient care experiences. Anesthesia and Emergency Departments are using simulation training to improve performance in emergency situations. (DeVita). An obstetrical simulation program promotes a rapid and organized response to these emergent situations. (
Obstetric Emergency Simulation drills were conducted at the obstetrical units of both Atlantic Health hospitals in 2008. The two sites include a regional perinatal center and a perinatal intensive center. The combined total number of annual deliveries for both sites was 6,300. All simulations utilized the same scenario and were facilitated by the same personnel to provide continuity. Simulation of a patient presenting in hypertensive crisis included at least one primary care provider (MD/CNM) and two or more nurses. During the simulation experience, the use of antihypertensive and anti-convulsant medication administration was reviewed. 95% of obstetric nurses, 93% of obstetric hospitalists, and 63.5% of private attending obstetricians and certified nurse midwives at both hospital sites participated in the simulations.
The objective was to determine if the implementation of obstetric simulations specific to hypertension in pregnancy would have an impact on the care of patients.
Methods
The implementation of an electronic medical documentation system allowed for systematic data collection before and after Obstetric simulation was introduced during the second quarter of 2008. The data generation and reporting provided by this clinical decision support system increased the breadth of data that can now be accessed electronically. A retrospective chart review was conducted for all patients admitted for delivery in the Obstetrical unit at two acute care sites of Atlantic Health between January 1, 2008 and December 31, 2008.
Results
During the first quarter of 2008, prior to the implementation of the simulations, patients were administered antihypertensive medication for a systolic blood pressure greater than 180 mm Hg or 100 mm Hg diastolic 23% of the time at site A and 39% of the time at site B. During the fourth quarter, antihypertensive medications were administered for a systolic blood pressure greater than 180 mm Hg or 100 mm Hg diastolic 85.7% of the time at site A and 60% of the time at site B. This illustrates an increasing trend of administration of anti-hypertensive medication to patients experiencing hypertension.
Discussion/Conclusions
The implementation of Obstetric Simulations specific to hypertension in pregnancy increased the appropriate administration of antihypertensive medication to patients experiencing significant hypertension. Results were limited by sample size. Atlantic Health will continue to collect data to determine if this trend continues. Repeating this study in other settings should be considered.
